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Borderline personality disorder is a complex mental illness marked by unstable moods, behaviors, and relationships. People with the condition may struggle with self-image problems, feelings of self-doubt, intense fear of abandonment, and low self-worth.
Individuals with BPD often have trouble controlling their emotional reactions, which can lead to self-harm and suicidal behaviors. It is common for people with this disorder to have high rates of co-occurring disorders, such as substance use disorders, depression, anxiety disorders, and eating disorders.
Mental health experts agree that the name “borderline personality disorder” can be misleading; however, a more accurate term does not yet exist. The good news is that when BPD is accurately diagnosed, treatment can be successful and individuals can go on to lead meaningful and productive lives.
BPD can be provisionally diagnosed in adolescents when symptoms persist for more than one year. While by nature the personality of adolescents is still developing, the diagnosis of BPD can be made with great care and on the basis of a thorough history and evaluation of an adolescent’s thinking style, emotional coping patterns, and interpersonal mode of functioning.
Treatment focuses on behavioral therapies or psychotherapies and medications, as appropriate to the specifics of the individual’s symptoms.
Dialectical behavior therapy (DBT) was created as a treatment model for those with BPD. The method emphasizes the development of four skill sets: mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance. Mindfulness practice involves increasing self-awareness by learning to focus on one’s experience of the present moment. A combination of cognitive behavioral techniques and mindfulness principles are employed to help people gain better control over their impulsive self-destructive behavior and to allow for a different way of managing intense feelings.
DBT was initially developed to treat suicidality in adults with BPD. However, it now is being used effectively in adolescents with similar self-harm behaviors as well as in other co-occurring psychiatric illnesses such as depression and anxiety. DBT has been clinically tested for its effectiveness in adolescents and adults.
It’s estimated that 1.6% of the adult U.S. population has BPD, but it may be as high as 5.9%. Nearly 75% of people diagnosed with the condition are women, but recent research suggests that men may be almost as frequently affected. In the past, men with BPD were often misdiagnosed with PTSD or depression.
Mentalization-based treatment (MBT) is a manualized, evidence-based treatment that focuses on helping people to differentiate and separate their own thoughts and feelings from those around them. Individuals with BPD often find it difficult to recognize the effect their behavior has on other people, which can lead to interpersonal problems and impulsive behavior. Mentalization refers to the ability to focus and reflect on mental states (e.g., beliefs, intentions, feelings, and thoughts) in oneself and in others. MBT seeks to develop and strengthen the individual’s capacity for mentalization, with the goal of improving interpersonal relationships and affect regulation.
Currently, there are no medications approved by the U.S. Food and Drug Administration (FDA) to treat borderline personality disorder. However, many people with BPD are treated with medications, in addition to psychotherapy, that can be helpful in managing specific symptoms such as anxiety or depression.
General psychiatric management (GPM) for patients with BPD is an evidence-based treatment developed by John G. Gunderson, MD. GPM was designed to be an outpatient intervention that could be easily delivered by community mental health professionals. GPM includes education for patients and their families, a persistent focus on the patient’s life outside of therapy, and a focus on big goals (e.g., stable partnerships and vocations). The treatment is often delivered as once weekly individual therapy and combined with other treatments such as medication management, family interventions, and group therapy.
Transference-focused psychotherapy (TFP) is a manualized, evidence-based treatment. TFP focuses on the patient’s confused and contradictory sense of identity, which is associated with problems with interpersonal relationships, self-esteem, and mood regulation. TFP helps patients learn to verbalize what they are feeling, rather than acting impulsively on emotions. The ultimate goal of this treatment is to create more stable and realistic experiences of self and others, resulting in increased functioning and satisfaction with interpersonal relationships.
You may find these resources valuable to understand more about borderline personality disorder:
McLean Hospital has been at the forefront of BPD research. Our researchers have provided critical insight into the causes and treatment of the disease and today continue to look for more knowledge on the disorder in order to find improved treatment methods.
John G. Gunderson, MD, was a pioneer in borderline personality disorder research. His seminal studies on BPD helped transform the diagnosis from a psychoanalytic construct into a scientifically proven and internationally recognized disorder and earned him recognition as the “father” of this disorder. He also developed the evidence-based therapy general psychiatric management (GPM), which he and fellow McLean clinicians teach throughout the country.
Lois W. Choi-Kain, MEd, MD, is the medical and program director of the Gunderson Residence and director of the Gunderson Personality Disorders Institute at McLean Hospital. Her areas of specialization include attachment, personality disorders, and psychotherapy, along with an integration of evidence-based treatments for BPD. In addition to her clinical work, she actively conducts research and publishes papers on BPD while also providing training for clinicians in general psychiatric management (GPM) and mentalization-based treatment (MBT) approaches.
Mary C. Zanarini, EdD, is the director of the Laboratory for the Study of Adult Development, which has been a part of many landmark discoveries in the field of BPD research. Her group of clinician-scientists was integral to the validation of BPD as a psychiatric disorder, and their work has also led to a now widely held theory of the causes of BPD. Dr. Zanarini has created numerous scales for assessing BPD in individuals and is a lead investigator in a number of longitudinal studies collecting research data on BPD over time.